Is Your Sex Hormone Level Too Low?

Dec 2014

The population of older men is increasing. In this age group the level of the male sex hormone testosterone falls and a significant number of men over age 60 have low testosterone levels. Testosterone is not just the key to sexual function but affects multiple organs and functions throughout the body. Testosterone deficiency in the middle-aged and elderly known as "late onset hypogonadism" (LOH) is typically characterised by a low sex drive ("libido") and impotence ("erectile dysfunction" - ED) but it can also cause decreased muscle mass and strength, loss of bone density ("osteoporosis"), increased body fat, lack of energy and depression. Any of the symptoms must correlate with a persistently low early morning testosterone level to confirm diagnosis.

LOH is often associated with other chronic illnesses such as Type II diabetes, chronic lung disease, rheumatoid arthritis, kidney disease, obesity and others. Therefore, all men presenting with ED or diminished libido should have, as a minimum, measurement of early morning serum testosterone and be fully assessed for the commonly associated conditions of obesity, diabetes, prostate problems, circulatory and heart problems and side effects of medication. When low LOH co-exists with obesity, diabetes, high blood pressure and high cholesterol levels, this combination is termed "The Metabolic Syndrome" and all aspects should be treated.

Men with ED should be treated with PDE5 Inhibitor drugs such as Sildenafil (Viagra), Vardenafil (Levitra) and Tadalafil (Cialis). Recent research on Cialis has shown that it is equally effective as alpha-blocker drugs such as Tamsulosin commonly used to treat benign prostate obstruction and can therefore be used to treat both conditions together.

If men with ED fail to respond to PDE5 Inhibitors and have low testosterone levels, they may then respond to treatment with testosterone. But testosterone treatment is not without risks and must be closely monitored. It cannot be used in men with or suspected of having prostate or breast cancer. When associated with other conditions such as diabetes and heart disease, these should be treated first.

In summary, LOH may be much commoner than suspected and is likely to increase as our population ages. It is frequently associated with other and potentially serious conditions which should be sought and addressed as a whole, not in isolation.

Chris Booth